- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.08 / $10.00 / $10.00
| Facility | | $7.08 | $10.00 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $7.08 / $10.00
| Professional | | $5.01 | $7.08 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.41 / $7.41 / $13.80
| Facility | | $7.41 | $7.41 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.76 / $14.13 / $17.78
| Professional | | $7.76 | $14.13 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $12.30 / $15.85
| Professional | | $10.96 | $12.30 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.32 / $13.49 / $79.43
| Facility | | $8.32 | $13.49 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.25 / $7.41 / $20.42
| Professional | | $5.25 | $7.41 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.49 / $14.13 / $15.85
| Professional | | $13.49 | $14.13 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.80 / $13.80 / $13.80
| Facility | | $13.80 | $13.80 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $20.42 / $20.42
| Professional | | $10.47 | $20.42 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.55 / $5.13 / $8.71
| Facility | | $3.55 | $5.13 | $8.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.79 / $6.17 / $11.22
| Professional | | $4.79 | $6.17 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.71 / $10.96 / $10.96
| Professional | | $8.71 | $10.96 | $10.96 |